Centers for Disease Control - CGH

Description

Voluntary Medical Male Circumcision (VMMC) is a one-time surgical procedure that reduces a male’s risk of heterosexually acquiring HIV for life. In 14 priority countries in eastern and southern Africa with generalized HIV epidemics where male circumcision is uncommon (either nationally or regionally), VMMC has the potential to reduce the rate of new HIV infections substantially and at a cost savings. Mathematical modeling suggests that if 8 out of 10 adult men will choose to become circumcised within 5 years, approximately 3.5 million new HIV infections may be prevented in 15 years, saving as much as $16.5 billion in HIV care and treatment costs. In 10 of the 14 priority countries, one case of HIV may be prevented for every 10 or fewer males who become circumcised in this scenario. VMMC programs also offer unprecedented opportunities to engage adolescent and adult men in health education and counseling, notably HIV testing and counseling services. Furthermore, males who are identified as HIV-positive by VMMC programs are referred for HIV care and treatment, broadening the potential community-level HIV prevention benefits of the program. As HIV prevalence decreases in men as a result of becoming circumcised, women’s likelihood of encountering HIV-infected partners are also reduced. In fact, almost half of the new HIV infections that may be prevented are among women, if scale-up is rapid, as described in the above modeling scenario. Women with circumcised male sex partners also have reduced risk of sexually transmitted infections, including carcinogenic strains of human papillomavirus (HPV) and associated cervical cancer. CDC and PEPFAR are committed to supporting service delivery programs that provide a comprehensive minimum package of clinical and prevention services including: offer (and availability) of HIV testing and counseling for all men and, where possible, their partners attending VMMC services; active referral of clients determined to be HIV-positive to HIV care and treatment programs; age-appropriate sexual risk reduction counseling and counseling on the need for abstinence from any sexual activity during wound healing; pre-procedure clinical screening (focused physical examination and medical history) to detect STIs and contraindications to circumcision; treatment of STIs that are detected; circumcision by a medical method recognized by WHO (surgery or device); post-procedure follow-up, including systematic assessment of adverse events; and, promotion of correct and consistent use of condoms. Assuring the safety and quality of services is the highest priority for VMMC programs, and mechanisms for assessing and ensuring the ongoing quality and safety of services must be in place. In carrying out the implementation and scale-up of VMMC services in these resource-limited settings, CDC and PEPFAR recognize the need for Continuous Quality Improvement (CQI) and External Quality Assurance (EQA) assessments to assist partner country governments and implementing partners in monitoring VMMC service delivery programs to objectively gauge the safety, quality, and compliance of programs with clinical standards of care, international best practices, PEPFAR’s Technical Considerations and Policy Guidance. VMMC is featured prominently throughout the PEPFAR Blueprint: Creating an AIDS-free Generation http://www.pepfar.gov/documents/organization/201386.pdf. Action Step #3 is to increase the number of males who are circumcised for the prevention of HIV, and includes ten commitments to implement this Action Step. The Road Map for Smart Investments highlights VMMC as a vehicle for engaging men and boys to know their HIV status, and if positive, be linked with care and treatment services. By the end of 2013, PEPFAR reached the President’s 2011 World AIDS Day goal of directly supporting 4.7 million VMMC procedures for HIV prevention. This FOA builds on these very successful efforts and will continue to support ongoing PEPFAR activities in the 14 priority countries to scale-up program activities to reach an 80% coverage in VMMC among males aged 15- 49 years through improvements in the availability, integration, safety, and quality of HIV prevention, care and treatment services.

Who can apply

• Others

Contact

Priyanka Rathod<br/>wnv9@cdc.gov<br/>
wnv9@cdc.gov